Physical function & physical activity are critical in the context of healthy ageing

Keenan Aliyah Ramsey

Research output: PhD ThesisPhD-Thesis - Research and graduation internal

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Abstract

Contributed to by a number of environmental, health and personal factors, ageing is associated with lifestyle and behavioral changes, including reduced physical activity and increased sedentary behavior as well as physiological changes, including the loss of muscle mass and subsequent physical function. Both physical function and physical activity have significant clinical relevance as both determinants and outcomes of health in older age and are interrelated. Establishing foundational epidemiological evidence prior to intervention, specifically the identification of factors associated with physical function and physical activity, is required to address low physical activity and poor physical function in public health and clinical practice. This dissertation addressed physical function and physical activity, their potentially modifiable determinants, the clinically relevant outcomes they are associated with, and their interrelation within the context of healthy ageing. In addressing this topic, this dissertation paid particular attention to the specific aspects of physical function (including different physical performance tests and activities of daily living) and physical activity (including duration, volume, intensity, accumulation, frequency, and sedentary behavior) by measuring and analyzing them individually (rather than as composite measures) and providing comparisons. Furthermore, to enhance generalizability, standardized measures were utilized and clinically relevant populations, (general population, geriatric outpatients, and geriatric inpatients0 were studied. Part I: Healthy ageing assessment provides the context and an overview of the measures used throughout this dissertation. It includes the introduction (Chapter 1), and Chapter 2, which describes the development of a standardized and multidimensional toolkit to assess health status (domains: socio-demographics, general health, nutrition, physical activity and physical performance, and psychological and cognitive health) in older adults. Part II: Evaluation of physical function in older adults explores the modifiable determinants and clinically relevant outcomes of physical function. Chapter 3 compares the associations of malnutrition with physical function measured by different physical performance tests in geriatric outpatients. Chapter 4 evaluates the association of changes in physical function during geriatric inpatient rehabilitation by measuring different physical performance tests at admission and discharge with subsequent short-term readmission, institutionalization, and mortality. Part III: Evaluation of physical activity in older adults explores the modifiable determinants and clinically relevant outcomes of physical activity and sedentary behavior. Chapter 5 studies the association of knowledge of nutrition and physical activity (lifestyle) guidelines with physical function measured by physical performance and physical activity in Dutch older adults attending a public engagement event. Chapter 6 describes the impact of receiving home-based hospital care vs. hospital-based care on objectively measured physical activity and sedentary behavior in geriatric rehabilitation inpatients. Chapter 7 and Chapter 8 summarize the associations of objectively measured physical activity and sedentary behavior with measures of physical function, skeletal muscle strength and muscle power, and activities of daily living and instrumental activities of daily living, respectively, through systematic reviews of the literature. Chapter 9 systematically summarizes the associations of objectively measured physical activity and sedentary behavior with fear of falling, falls, and fractures. Chapter 10 provides a systematic review, meta-analysis, and meta-regression analysis of studies reporting on the association of instrumented physical activity and sedentary behavior and mortality. Part IV: Synthesis of findings summarizes and synthesizes the results presented in this dissertation. It includes a summary review article, Chapter 11, which synthesizes standardized associations from a series of systematic reviews including those presented in Chapters 7-10 and provides a comparative analysis to determine the strongest parameter of physical activity and sedentary behavior in determining clinically relevant outcomes, and the clinically relevant outcome most strongly associated with physical activity and sedentary behavior. The final chapter, Chapter 12, presents a general discussion that reflects on the main findings in context and provides directions for future research.
Original languageEnglish
QualificationPhD
Awarding Institution
  • Vrije Universiteit Amsterdam
Supervisors/Advisors
  • Maier, Andrea, Supervisor
  • Whittaker, Anna, Supervisor, -
  • Meskers, Carolus Gerardus Maria, Co-supervisor, -
  • Trappenburg, M., Co-supervisor, -
Award date1 Nov 2021
Publication statusPublished - 1 Nov 2021

Keywords

  • Physical activity, physical function, older adults, aged, accelerometry, physical performance, sedentary behavior, geriatric assessment, subacute care, community dwelling

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